Paramedics as Hospital Unit Managers?

[CANDawg]

I came across an article in my regulatory body's regular newsletter outlining how a Paramedic recently took on a role as a unit clerk in a major hospital. (Page 10 at http://www.collegeofparamedics.org/media/106334/emd_fallwinter_2012.pdf. Be warned: The rest of the stuff in there is pretty boring.)

Thoughts? It's quite clearly a move from paramedicine into a role dominated by nurses, I'm surprised we aren't hearing a lot of backlash from the nurses union as of yet. I'm also not sure how she will transpose her job requirements into the EMT-P scope of practice.

 

[Summit]

I came across an article in my regulatory body's regular newsletter outlining how a Paramedic recently took on a role as a unit clerk in a major hospital. (Page 10 at http://www.collegeofparamedics.org/media/106334/emd_fallwinter_2012.pdf. Be warned: The rest of the stuff in there is pretty boring.)

Thoughts? It's quite clearly a move from paramedicine into a role dominated by nurses, I'm surprised we aren't hearing a lot of backlash from the nurses union as of yet. I'm also not sure how she will transpose her job requirements into the EMT-P scope of practice.

Unit clerk is NOT a role dominated by nurses. It is a secretarial job with occasional janitorial duties.

Unit clerk doesn't need ANYTHING cert wise. They are not a patient care tech, orderly or CNA (less training than EMT). Although, it is not uncommon to find a CNA in that role or more rarely an EMT. Unit clerks rarely do patient care although in some facilities they may double in the role of a CNA or may even start IVs once their paperwork duties are done. Usually, unit clerks handle paperwork, chart preparation and transfer, answer the phones, call for services, and may work on payroll, deliver meals or prepare rooms for new patients.

That Paramedic has found a job that has almost nothing to do with Paramedicine.

All that said, a good unit clerk is worth their weight in gold.

 

[CANDawg]

Interesting. I'll be the first to admit that I am far from an expert on the subject, but I was under the impression that the role was more of a managerial one, responsible for leading and managing a nursing team in a particular section of the facility.

If it is in fact more what you describe, then I completely agree this is far from something to take much notice of.

 

[Summit]

I now notice you are in AB. I describe it for the USA. Reading that article, it sounds more as you describe although the article states this person manages some LPNs and aides, perhaps like a charge nurse. I am not well versed in how that works in your system, what it entails exactly? It does seem an odd place for a prehospital professional without the years of experience in multidisciplinary hospital care, particularly without the nursing background. As described, the position would not be a fit for an American paramedic.

 

[Jon]

Well, I changed the thread title to make it a little clearer.

A unit clerk is just that - a clerk. While it helps to have some medical knowledge, their biggest job is organization.

A unit manager? That's different. From the half-page article, it sounds almost like a charge nurse. In many parts of the US, a unit manager is a full-time manager who oversees the unit 24x7 - schedule, personnel, etc. Both are traditionally RN roles, usually with a BSN (or MSN for the manager role).

I don't see why a Charge Nurse couldn't be a paramedic instead of a nurse in many settings. Many of the bigger ED's have a charge RN (or 1 per Pod) that DOESN'T carry any primary patients. Their main job is to organize and coordinate, and to help support the other RN's. Depending on hospital clinical rules, medics might be able to do much of that skill set - but I'm pretty sure the nurses wouldn't like it.

 

[VFlutter]

As others have mentioned the charge nurse role is mostly clerical and involves coordinating, scheduling, Admit/Discharge, checking crash cart, dealing with patient families, etc but can involve clinical duties. The charge has no patients so they are free to help RNs as needed and usually help with difficult or critical patients. At most hospitals this role requires a BSN.

I am sure a paramedic *could* perform the role, probably more so in the ER, but I do not think they are really the best candidates. Not sure what the education for medics is in AB but if it is anything like the US then I do not see anything in their education that would prepare them for the role.

The BSN education is geared towards preparing RNs for these types of roles.

 

[Summit]

I don't see why a Charge Nurse couldn't be a paramedic instead of a nurse in many settings. Many of the bigger ED's have a charge RN (or 1 per Pod) that DOESN'T carry any primary patients. Their main job is to organize and coordinate, and to help support the other RN's. Depending on hospital clinical rules, medics might be able to do much of that skill set - but I'm pretty sure the nurses wouldn't like it.

In the US, paramedics are not trained for that role. Perhaps in the few hospitals in the US that use paramedics as full scope techs in the ED it could work with a paramedic who has worked in that role for a while. But, outside of a full scope ED tech, that could be a disaster as the medic wouldn't otherwise have the understanding or experience of the roles being managed or assigned. How would a medic be qualified to oversee RNs, make assignments, anticipate services, transfers, etc etc etc? Further, step outside the ED, the paramedic would be pretty lost. You want a paramedic making assignments on a surgical floor or ensuring the SICU RNs are managing their patients properly?

Remember, the charge nurse is usually expected to be a resource for the other RNs when the SHTF. They also liaise with other departments and services when there are problems or disagreements (is the guy with a certificate and a high-school diploma going to mediate a BSN's questioning of an MD's order for something the paramedic never learned about in school?). Plenty of places Charge With Patients or at least the charge covers the patients while staff break for lunch, and the paramedic could not step into those roles in most cases.

 

[JPINFV]

As others have mentioned the charge nurse role is mostly clerical and involves coordinating, scheduling, Admit/Discharge, checking crash cart, dealing with patient families, etc but can involve clinical duties. The charge has no patients so they are free to help RNs as needed and usually help with difficult or critical patients. At most hospitals this role requires a BSN.

I am sure a paramedic *could* perform the role, probably more so in the ER, but I do not think they are really the best candidates. Not sure what the education for medics is in AB but if it is anything like the US then I do not see anything in their education that would prepare them for the role.

The BSN education is geared towards preparing RNs for these types of roles.

Putting a paramedic in that role is like making an EMT a field manager. When there's friction between the medical staff and the nursing staff, do you want to know who the attending goes to first?

 

[DrParasite]

Putting a paramedic in that role is like making an EMT a field manager. When there's friction between the medical staff and the nursing staff, do you want to know who the attending goes to first?

and what's wrong with an EMT being a field manager? If they aren't supposed to be clinical supervisors, they should have no problems acting as operational supervisors in the field. especially if they have management and supervisory training (which typically has 0 to do with clinical abilities)

and just think, why can a nurse be in charge of a floor if medical staff are better trained?

 

[Summit]

and what's wrong with an EMT being a field manager? If they aren't supposed to be clinical supervisors, they should have no problems acting as operational supervisors in the field. especially if they have management and supervisory training (which typically has 0 to do with clinical abilities)

Why an EMT? How about a CNA with experience in fast food management?

On point, we should leave nursing management to experienced nurses with management/leadership experience/training.

Anyway, besides that point, charge nurses are expected to be clinical supervisors, evaluate clinical performance, and liaison between nursing and other clinical services.

 

[firecoins]

Nursing unions would never let a nursing job go to a non RN. MDs and PAs would not be allowed to fill the rules, at least not in NY.

Management skills are not taught to EMTs, paramedics or ADNs. Unless one has an outside degree in management it would be difficult to even the ADN in that role. Than there is an issue with scope of practise. Most EMS personnel are not educated in RN scope of practise.

 

[Medic Tim]

It is common to find paramedics working in hospitals as paramedics with full to expanded scope in certain areas. It is not uncommon for bls medics to do triage and for advanced and critical care (real critical care license not a merit badge course) medics to work in the er and icu. More and more areas are looking into doing this. It was just a matter of time before these medics became some sort of management.

The training Canadian medics have is usually quite a bit more/longer than most us programs have. For a critical care medic you would have around 4 years training plus clinical/internship With at least a year or 2 experience at each level before moving up.

The ontario bls medic (pcp)training is 2 years.... Their scope is about that of an AEMT or iiI-85 in the us.

 

[JPINFV]

and what's wrong with an EMT being a field manager? If they aren't supposed to be clinical supervisors, they should have no problems acting as operational supervisors in the field. especially if they have management and supervisory training (which typically has 0 to do with clinical abilities)

...because field supervisors are clinical supervisors when things go wrong. Do you think that the person calling in because of shoddy care is going to make a distinction between a clinical supervisor and a field supervisor? Are you going to have a clinical supervisor on call or on duty at all times in addition to a field supervisor?

and just think, why can a nurse be in charge of a floor if medical staff are better trained?

1. Nurses like playing the "Only a nurse can judge a nurse" card.

2. I don't know many physicians who would want to be unit managers.

3. Outside of very specific fields, physicians aren't in the hospital for set shifts. The IM physician managing inpatients is going to come in, see his patients, write a progress note, write any new orders, do any needed procedures, and fill out any needed paperwork and go home. Physicians generally aren't sitting around the hospital waiting for their shift to get over, especially if they have an outpatient clinic to run.

 

[Summit]

It would be a waste of a physician to be a unit manager. It would be a waste of a PA or an NP as well. As JP points out, none of them would want the job either.

Advanced clinical practice is reached through furthering education to a Certified Nurse Specialist, Nurse Practitioner, CRNA etc through a masters or doctorate degree in nursing practice. These folks do not end up as unit managers because their graduate education is in clinical practice, as with a PA, MD, DO, etc.

If they want the unit educator role, they usually do a MS in Clinical Nurse Leadership or Nursing Education. A PA, NP, or MD/DO could do this, but they don't want to.

Nurses who wan the management track beyond charge nursing usually take their BSN on to a MS/MBA in Health Services Leadership and Management, or a MHA Masters in Healthcare Administration.

 

[Tigger]

Well, I changed the thread title to make it a little clearer.

A unit clerk is just that - a clerk. While it helps to have some medical knowledge, their biggest job is organization.

A unit manager? That's different. From the half-page article, it sounds almost like a charge nurse. In many parts of the US, a unit manager is a full-time manager who oversees the unit 24x7 - schedule, personnel, etc. Both are traditionally RN roles, usually with a BSN (or MSN for the manager role).

I don't see why a Charge Nurse couldn't be a paramedic instead of a nurse in many settings. Many of the bigger ED's have a charge RN (or 1 per Pod) that DOESN'T carry any primary patients. Their main job is to organize and coordinate, and to help support the other RN's. Depending on hospital clinical rules, medics might be able to do much of that skill set - but I'm pretty sure the nurses wouldn't like it.

If I was a nurse, I would want my supervisor to be a nurse. From a management perspective it makes no sense to make a paramedic in charge of a unit of nurses, especially since the paramedic lacks a nurse's education. I don't think any of us would like it if our field supervisor was a nurse (excluding areas where the whole MICN thing exists).

 

[MagicTyler]

Where I used to work a paramedic was in the role of Emergency Department operation manager. She over saw all of the techs, did all of the department ordering, and over saw a tin of other tasks. She didn't over see any nurses directly but was considered one of the department administrators and could make executive decisions.

That same hospital also had a paramedic pre-hospital director.

 

[silver]

If I was a nurse, I would want my supervisor to be a nurse. From a management perspective it makes no sense to make a paramedic in charge of a unit of nurses, especially since the paramedic lacks a nurse's education. I don't think any of us would like it if our field supervisor was a nurse (excluding areas where the whole MICN thing exists).

As far as I know a nurse's manager by convention are nurses. This is because a nurse should not be supervised by non-nurses in regards to nursing services. In the overal hospital scheme, they are typically under a "chief nurse," then directors of some capacity, and then managers. Obviously they would also be under the "medical director," but they don't report directly to said MD/DO. This then logically explains why a charge nurse would be a nurse.


Also where I am a unit clerk is the secretary which means they act as a workhorse and all around "handy-man." The overall goal is making sure the unit runs smoothly. On a busy unit, I think they have the most difficult job hands down.